Abstract

PIP: The author considers that the 2 cases, described in a previous article, do not provide an adequate cause-and-effect link between copper-containing IUDs and limb-reduction defects. Conception in 1 of the cases may have occurred after expulsion of the IUD, and the lead content of the Grafenberg ring may have been the cause. No congenital abnormalities were reported in another series of 317 pregnancies occurring during use of IUDs and reaching viability. In 2 international studies there were 20,684 insertions of the copper-T (Gravigard) device and 714 pregnancies resulted with the devices in place. Of these 167 reached viability, 8% were lost to follow-up, and the others were ectopic or ended in abortion. Normal babies followed in 159. The incidence of congenital defects was 8 (4.8%) which was near the expected rate. No limb-reduction defects were found in this series. In a report of 23 other pregnancies going to term with an IUD in place, 19 normal infants and 4 with congenital abnormalities were reported. Of the abnormalities, 1 had multiple limb-reduction deformities. This is the only such case reported in Britain since the Gravigard was marketed in 1972. Since then 376,000 of these devices have been sold in the British Isles. The likelihood of spontaneous abortion and of other dangerous complications of pregnancy and delivery is such that pregnancy might best be terminated when an IUD is present. However, a copper-T device is not considered an added teratogenic risk.